An 81-year-old independently functional woman with a history of congestive heart failure presented with acute shortness of breath. The day prior to the presentation she complained of mild shortness of breath while having dinner but went to sleep and woke up early morning with difficulty in breathing and chest discomfort. Prior to this, she was hospitalized twice for heart failure in the last 3 months and was also diagnosed with left atrial myxoma. However, her family members refused surgery. She has no constitutional symptoms such as fever, fatigue, weight loss, etc. She was in respiratory distress (26 breaths per minute), hypoxic, saturating 88% on room air and tachycardic (120 beats …